| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
910 |
901 |
$57K |
| D1120 |
Prophylaxis - child |
1,498 |
1,490 |
$57K |
| D1206 |
Topical application of fluoride varnish |
1,186 |
1,178 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
237 |
$15K |
| D0272 |
Bitewings - two radiographic images |
293 |
292 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
775 |
381 |
$3K |
| D1351 |
Sealant - per tooth |
113 |
29 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
39 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
143 |
143 |
$1K |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$345.60 |
| D0350 |
|
19 |
14 |
$230.40 |